Background
Dissociation is the disruption of the normal integrative processes of consciousness, perception, memory, and identity that define selfhood.
Dissociative identity disorder is increasingly understood as a complex and chronic posttraumatic psychopathology closely related to severe, particularly early, child abuse. Children who have been maltreated or abused are at risk for experiencing a host of mental health problems, including dissociative identity disorder.
This condition is characterized by a) the presence of 2 or more distinct personality states or what some cultures may describe as an experience of possession, and b) recurrent episodes of amnesia.
The deleterious effects of childhood abusive experiences on growth and development have been well documented and are associated with various later mental health problems. Diagnosis of dissociative identity disorder is not usually made until adulthood, long after the extreme maltreatment thought to engender the condition has occurred. Therefore, although the most common cause of the disorder is agreed to be early, ongoing, extreme physical and/or sexual abuse, accounts of such abuse are usually provided retrospectively by the patient and lack objective verification. Researchers have shown that, in many instances, borderline personality disorder and posttraumatic stress disorder (PTSD) in adulthood may be traced to childhood abuse.
The existence of significant dissociative psychopathology related to physical and sexual abuse experienced in childhood was known to clinicians in the last century. However, only recently have modern mental health practitioners begun to appreciate implications of this forgotten linkage.
Clinical and research reports indicate that a history of physical and sexual abuse in childhood is more common among adults who develop major mental illness than previously suspected. Dissociation has also been linked specifically to childhood physical neglect in patients diagnosed with schizophrenia. Various degrees of dissociative disorders are recognized, ranging from passive disengagement and withdrawal from the active environment to multiple personality disorder (MPD), a severe dissociative disorder characterized by disturbances in both identity and memory and best understood as a posttraumatic, adaptive dissociative response to the fear and pain of overwhelming trauma, most commonly abuse. Fully expressed MPD is not often diagnosed as such in the pediatric population; however, other forms of dissociative disorders are not uncommon, as described in this article.